2015 New Vendor Application

Size: px

Start display at page:

Download "2015 New Vendor Application"

Liliana Welch
5 years ago
Views:

2015 New Vendor Application You must read the 2015 Green City Market Rules and Regulations prior to filling out this application. All vendors are responsible for the requirements described therein.

1 2015 New Vendor Application You must read the 2015 Green City Market Rules and Regulations prior to filling out this application. All vendors are responsible for the requirements described therein. Please answer all applicable questions as completely as possible. Applications are due by 11:59pm CST on February 3, This includes all supporting documents and the $50 application fee. Late applications will be accepted until 11:59pm CST on February 24, 2015 and will be subject to an additional, non refundable, late fee of $200 due at time of submission. Incomplete applications are also subject to the late fee. Electronic submission of application and all supporting documents via our website upload or is strongly preferred. Application Committee: Dave Cleverdon, Leslie Cooperband, Chris Djuric, Sheri Doyel, Bruce Sherman, Sarah Stegner, Tracey Vowell Market Founder: Abby Mandel ( ) Executive Director: Melissa Flynn Associate Director: Mark Psilos 2732 N. Clark Street, Suite 302 Chicago, IL (773)

2 I certify that I have read the 2015/2016 Rules and Regulations for Vendors CONTACT INFORMATION Vendor Contact Name: Business Name: Business Address: City: State: Zip: Preferred Phone: Alternate Phone: Address: Website Address: I am a(n): Individual Family LLC Partnership Corporation Other Is this your first time applying to Green City Market (GCM)? Yes No Other Farmers Markets where you sell I am applying as a Vendor Associate Vendor MARKET DAYS I am applying for the following market locations and days: (check all that apply) Lincoln Park (May-October) Wednesdays Saturdays Fulton (May-October, details TBD) Indoor Market (November-April, details will be circulated to accepted vendors by late summer) VENDOR TYPE Produced vegetables fruits grains flowers plants honey, maple syrup eggs Produced cont. dairy/cheese poultry/meat fish/seafood Ready to Eat Prepared jams, jellies canned foods cider breads, pastry other prepared foods Other 2

3 MARKET SPACE Fees for space and parking are outlined in the Rules and Regulations and billed after acceptance. How many 20 x20 spaces do you need? more, please specify Do you need access to electricity? Yes No If so, how many amps? Do you plan to bring a generator to Market? Yes No What type of vehicle do you plan to park at the Market? Van, Car, Pick-up truck, or Sprinter Box truck, Truck with trailer No vehicle SALES TAX AND INSURANCE A. Sales Tax: Please note that Illinois requires that sales tax be collected on the sale of food. Therefore, you must have an Illinois Sales Tax License before applying to this market and must include the License # below and attach a copy of the license to this application. Illinois Sales Tax License # (attach copy of license) B. Insurance: All applicants must carry commercial liability insurance ($1 million) and name Green City Market as an additional insured for protection against damages in the event an injury occurs at the Market or an injury is caused by the product(s) they sell at the Market. Insurance Co: Policy # Exp. Date: Coverage Limits: Per Occurrence: Aggregate: Agent Name: Agent Business Address: Business Phone: Attach a copy of your Certificate of Insurance naming Green City Market as additionally insured. See the sample in the Rules and Regulations, and request this from your agent. If your agent will be sending this directly to GCM, please request they do so via to admin@greencitymarket.org 3

4 GENERAL INFORMATION Please type your answers below or attach a separate sheet. A. Farm/ Business History: Please tell us a bit about the history of your farm or business. Would you consider your business a small or family operation? Please explain why or why not. B. Sustainability Statement: How do your farming practices and/or production methods ensure a high-quality product while demonstrating care for the environment, your business and your community? C. Fit for the Market: Given the Market s Mission, why is your business a good fit for Green City Market? _ 4

5 FARMER/PRODUCER INFORMATION (Prepared Food Only skip this section) A. Which 3 rd party certification for your production practices do you hold? Please check the box next to each certification you currently hold or are actively seeking and attach a copy of your current certificate or letter: USDA Certified Organic Animal Welfare Approved Certified Naturally Grown Certified Humanely Raised Food Alliance Certified and Handled Michigan Agricultural American Grassfed Environmental Assessment Association Certified Program (MAEAP) American Humane Certified Other: B. For every 3 rd party certification you hold or are actively seeking, please enter the following information: 1. Certifying Agency: Effective Date: Expiration (or Next Inspection) Date: Contact Information for certifying agency/ inspector: Name: Phone #: 2. Certifying Agency: Effective Date: Expiration (or Next Inspection) Date: Contact Information for certifying agency/ inspector: Name: Phone #: 3. Certifying Agency: Effective Date: Expiration (or Next Inspection) Date: Contact Information for certifying agency/ inspector: Name: Phone #: 5

6 C. Do you possess any certifications regarding food processing or food handling practices? If yes, please list: D. Crops to be grown Please attach an itemized crop list, using the form on the website or one of your own creation. E. Farm/Orchard Site Location Information Please list all sites including a map for each (show farm boundaries, growing areas, crop locations, and storage sheds, packing/processing facility locations). If items are wild gathered, identify the location(s) and attach a permission from the property owner where gathered. If the land is rented, shared, or leased please include contact information for the owner and attach a copy of the land agreement. If property is owned by you, please attach a copy of your latest property tax bill. 1. Land Description & Address: County: City: State: Number of Acres: Total Acreage in production: Greenhouse (# and total sq ft): Tunnels (# and total sq ft): Landlord: Phone: 2. Land Description & Address: County: City: State: Number of Acres: Total Acreage in production: Greenhouse (# and total sq. ft.): Tunnels (# and total sq. ft.): Landlord: Phone: 3. Land Description & Address: County: City: State: Number of Acres: Total Acreage in production: Greenhouse (# and total sq. ft.): Tunnels (# and total sq. ft.): Landlord: Phone: 4. Land Description & Address: County: City: State: Number of Acres: Total Acreage in production: Greenhouse (# and total sq. ft.): Tunnels (# and total sq. ft.): Landlord: Phone: 6

7 F. Products: 1. Do you grow and/or raise all products or ingredients that you plan to sell at the Green City Market? Yes No If No, Explain what, why, and where the products in question come from. 2. For Producers Only (meat, fish, poultry, eggs, dairy): Please list your licensed processing locations: Product Processor s Name & Location Licensed By License # USDA FDA Dept. of Health PROCESSOR/ PREPARED FOOD INFORMATION (Includes bakery goods, cheese and other dairy products, honey, jam and jellies, ciders, juice, maple syrup, candy, granola, sandwiches; all meat, fish and poultry items--frozen, cured, smoked, etc.; nonfood items) A. List all prepared food or other products you hope to sell at the market. For each product you list you must also submit an Ingredients List and source sheet (available for download at greencitymarket.org). Be sure to note what percentage of each ingredient is in the final product and highlight the local or Midwest grown ingredients used in your products. Refer to the Rules and Regulations for acceptable ingredients. If you have seasonal items, include the dates the items will be offered. Products not approved for immediate sale will be waitlisted and you will be contacted if or when the product is approved. Attach a sample of all product labels with application. Products that you plan to sell at GCM (be specific, please): Product Name Dates Available

8 Please attach an additional sheet if needed. Again, EACH item must be accompanied by an ingredient list (NOT a recipe, please see attached). B. List the major ingredients that you grow that go into your products. C. Do you personally oversee the production of your value-added products? Yes No Please describe how you are involved in making your products. D. If you use a co-packer or co-producer, please describe how you verify that the finished product actually contains the ingredients you provided. E. If you are required to have a health department license or safe food handling certificate, please attach a copy to your application. F. Licensed Food Processing Locations (Where products are fabricated): Product Processor s Name & Location Licensed by License # 8

9 H. The State of Illinois prohibits the sale of fresh meat and poultry. These products must be frozen. If you intend to sell meat and/or poultry, they must be kept at a temperature below 0 degrees Fahrenheit. The vendor is responsible for monitoring and maintaining proper temperatures in accordance with health codes. Vendors who sell products that must be kept refrigerated or frozen must have an accurate thermometer on-site. In addition to frozen meat and poultry; eggs, dairy, and cheese must be held at 45 degrees Fahrenheit. Initial here if you will sell these products and understand these regulations. I. How do you keep potentially hazardous foods at correct Health Department temperatures during transportation and at market? J. If you plan to prepare food at the market please fill out the Temporary Food Vendor License Application available on the website. K. Is your product certified organic? Yes No Please attach all necessary documentation to support this. ADDITIONAL INFORMATION If you are unable to supply a particular document at this time, and will be submitting it later or separately, or if you have any other notes pertaining your application materials please add them here. 9

10 AFFIDAVIT I have read the Green City Market 2015/2016 Rules and Regulations for Vendors. If accepted to Green City Market, I agree to abide by all the market Rules and Regulations and to sell at the Green City Market only such items as those listed on the attached "Products to be Sold" page. I also acknowledge those products must be of my own production or produced at the location described on my application. I acknowledge full responsibility for all my activities in the market (and for those assisting me) throughout the term of this season's market (May 2, April 30, 2016). I acknowledge the authority of GCM Staff to immediately settle any disputes regarding product legitimacy, procedural and vendor conduct violations, and impose any penalties, including possible suspension or removal from the Market, subject to appeal under the procedures set forth in the Market Rules and Regulations. I agree to allow GCM Staff and/ or representatives of GCM at any time to inspect the premises where the products offered for sale are produced. Failure to allow an inspection will constitute a violation of GCM rules. I understand that the GCM does not carry any insurance policies to cover individual participants and that I am required to carry such insurance. I certify that the information contained in this application is true and accurate. Name of Business: Signature: Date: (Electronic Signature) Signature: Date: (Typed Signature- if you can not sign electronically) 10

Date selection form NAME OF BUSINESS: CONTACT PERSON: PHONE NUMBER: BOOTH SIZE (CHECK ONE): O 10X10 O 10X20

Date selection form NAME OF BUSINESS: CONTACT PERSON: PHONE NUMBER: BOOTH SIZE (CHECK ONE): O 10X10 O 10X20 Date selection form Welcome to the Ravenswood Farmers Market! Please fill out the information below and return it with your application. There is no booth fee for the 2018 season. Notice of cancellation